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Abstract Background We present a unique case of rhinolalia as the first recognizable sign of spontaneous pneumomediastinum and surgical emphysema following drug use. Case presentation This case presents a 17-year-old white male experiencing rhinolalia following ecstasy ingestion at a rave. Subsequent chest X-ray revealed extensive surgical emphysema, along with a continuous diaphragm sign indicative of pneumomediastinum. Computed tomography confirmed the diagnosis. The patient was managed conservatively with strict monitoring and 6 hourly electrocardiograms. Follow-up computed tomography on day 3 showed resolution of pneumomediastinum and surgical emphysema, and the patient was safely discharged. Notably, the patient experienced a temporary rhinolalia during the acute phase, which resolved spontaneously as his condition improved. Conclusions This case underscores the importance of considering spontaneous pneumomediastinum and surgical emphysema in the differential diagnosis of young individuals presenting with acute symptoms after drug use.

Background: We present a unique case of rhinolalia as the first recognizable sign of spontaneous pneumomediastinum and surgical emphysema following drug use. Case presentation: This case presents a 17-year-old white male experiencing rhinolalia following ecstasy ingestion at a rave. Subsequent chest X-ray revealed extensive surgical emphysema, along with a continuous diaphragm sign indicative of pneumomediastinum. Computed tomography confirmed the diagnosis. The patient was managed conservatively with strict monitoring and 6 hourly electrocardiograms. Follow-up computed tomography on day 3 showed resolution of pneumomediastinum and surgical emphysema, and the patient was safely discharged. Notably, the patient experienced a temporary rhinolalia during the acute phase, which resolved spontaneously as his condition improved. Conclusions: This case underscores the importance of considering spontaneous pneumomediastinum and surgical emphysema in the differential diagnosis of young individuals presenting with acute symptoms after drug use. [ABSTRACT FROM AUTHOR]

Background: Subcutaneous emphysema is a condition where air becomes trapped under the skin, typically resulting from surgery or skin trauma. It is mostly localized and its occurrence in blood donors is exceedingly rare. Phlebotomy poses minimal risk of subcutaneous emphysema, but procedural errors may lead to such complications. Study Design and Method: This is a case report of 29‐year‐old repeat blood donor who experienced subcutaneous emphysema following blood donation. The donor was vigorously squeezing sponge ball during donation resulting in displacement of the needle which required readjustment. Post‐donation, the donor reported a crackling sensation and mild swelling near phlebotomy site. Non‐contrast computed tomography (NCCT) scans confirmed subcutaneous emphysema, attributing its development to air trapping in subcutaneous plane due to ball valve mechanism. Results: Computed tomography (CT) imaging revealed subcutaneous emphysematous changes in the right cubital region and no evidence of hematoma. The swelling spontaneously subsided in 10–12 days without any intervention. The case underscores the importance of differentiating subcutaneous emphysema from common complications like hematoma. Discussion: Subcutaneous emphysema in blood donors is exceptionally rare but should be managed with clear communication. Donors should be reassured that the condition, although rare, is benign and self‐resolving. Healthcare providers should be equipped to handle such rare complications, offering appropriate care and documenting incidents for future prevention. [ABSTRACT FROM AUTHOR]

Literature evidence on sub‐cutaneous drain insertion in severe surgical emphysema (SE) is lacking. We retrospectively reviewed the clinical notes of 5 patients who underwent insertion of sub‐cutaneous drains to manage SE of various aetiologies between September 2022 to August 2023 in a single district general hospital in the UK. Case history, outcome following sub‐cutaneous drain insertion, and side effects due to the procedure were collected. Clinical decompression were noticed within an hour of drain insertion in all patients. Radiological resolution ranged between 2 and 10 days with a median 3 days and mean of 4.8 days. Patients with uni‐lateral sub‐cutaneous drain required more time for radiological improvement than patients on bi‐lateral drains (median 6.5 vs. 2, mean 6.5 vs. 3.6). Maximum duration for resolution was 10 days for patients receiving uni‐lateral sub‐cutaneous drain versus 7 days in patients having bi‐lateral drains. Only one patient had no prior lung disease making it difficult to comment if having healthy lungs affects outcomes. Sub‐cutaneous drain insertion is a safe procedure which can accelerate recovery in severe SE.Literature evidence on sub‐cutaneous drain insertion in severe surgical emphysema is lacking. In this article, we present a retrospective analysis of a case series consisting of five patients suffering from pneumo‐mediastinum and severe surgical emphysema successfully treated with subcutaneous drainage. [ABSTRACT FROM AUTHOR]

This case report describes a 69-year-old male patient who underwent laparoscopic inguinal hernia repair using a total extraperitoneal approach. Complications during the procedure were hypercarbia, surgical emphysema, and pneumothorax. Immediate interventions were necessary to address the rising end-tidal CO2 levels, hypercarbia, and acidosis. The incidence of these complications may be higher than previously reported, particularly in extraperitoneal laparoscopic procedures, underscoring the importance of increased awareness among anaesthesiologists. This case report emphasises the significance of monitoring CO2 inflation pressure, assessing subcutaneous CO2 accumulation, and adjusting ventilation to enhance patient safety and promote the reporting of such complications in the future. [ABSTRACT FROM AUTHOR]

Pneumomediastinum (PNM) is a rare clinical finding, usually with a benign course, which is managed conservatively in the majority of cases. However, during the COVID-19 pandemic, an increased incidence of PNM has been observed. Several reports of PNM cases in COVID-19 have been reported in the literature and were managed either conservatively or surgically. In this study, we present our institutional experience of COVID-19 associated PNM, propose a management algorithm, and review the current literature. In total, 43 Case Series were identified, including a total of 747 patients, of whom 374/747 (50.1%) were intubated at the time of diagnosis, 168/747 (22.5%) underwent surgical drain insertion at admission, 562/747 (75.2%) received conservative treatment (observation or mechanical ventilation. Inpatient mortality was 51.8% (387/747), while 45.1% of the population recovered and/or was discharged (337/747). In conclusion, with increased incidence of PNM in COVID-19 patients reported in the literature, it is still difficult to assign a true causal relationship between PNM and mortality. We can, however, see that PMN plays an important role in disease prognosis. Due to increased complexity, high mortality, and associated complications, conservative management may not be sufficient, and a surgical approach is needed. [ABSTRACT FROM AUTHOR]

Pneumomediastinum (PNM) is a rare clinical finding, usually with a benign course, which is managed conservatively in the majority of cases. However, during the COVID-19 pandemic, an increased incidence of PNM has been observed. Several reports of PNM cases in COVID-19 have been reported in the literature and were managed either conservatively or surgically. In this study, we present our institutional experience of COVID-19 associated PNM, propose a management algorithm, and review the current literature. In total, 43 Case Series were identified, including a total of 747 patients, of whom 374/747 (50.1%) were intubated at the time of diagnosis, 168/747 (22.5%) underwent surgical drain insertion at admission, 562/747 (75.2%) received conservative treatment (observation or mechanical ventilation. Inpatient mortality was 51.8% (387/747), while 45.1% of the population recovered and/or was discharged (337/747). In conclusion, with increased incidence of PNM in COVID-19 patients reported in the literature, it is still difficult to assign a true causal relationship between PNM and mortality. We can, however, see that PMN plays an important role in disease prognosis. Due to increased complexity, high mortality, and associated complications, conservative management may not be sufficient, and a surgical approach is needed.

Abstract Background Blunt traumatic airway injury is a life-threatening injury in which urgent management is pivotal and this would come through improving our clinical management and diagnostic tools. Our objective was to emphasize the importance of early referral and urgent surgical repair of major airway injury. Results Records of 42 patients with major airway injury out of 17,520 registered thoracic trauma cases were reviewed over the past 15 years. Twenty-eight cases documented to have major tracheobronchial injuries due to blunt trauma underwent surgical repair either urgent (21 cases) or late (7 cases). The age ranged from 8 to 43 years old with a mean age of 22.3 ± 0.8. The most common presenting symptom was shortness of breath in 22 (78.6%) cases and the most frequent sign was subcutaneous emphysema which was seen in 22 (78.6%) cases. The postoperative morbidity and mortality rates were significantly higher in the delayed repair group (p value < 0.001). Conclusion The urgent surgical repair is the treatment of choice for major airway injury which is facilitated by early recognition and referral. It is pivotal to avoid respiratory and systemic complications and related mortality.

Abstract: Background: Subcutaneous emphysema is a common presentation to the emergency department. The presence of emphysema in the head and neck region due to dental procedure is not common, and the presence of pneumomediastinum is exceedingly rare. Case Report: A young lady, presented to the emergency department with chest pain, found to have pneumomediastinum following a dental procedure including a wisdom tooth extraction. Conclusion: Complications following dental procedures are not uncommon, hence there should be a high index of suspicion for the emergency physicians for such patients, especially those where air turbine dental tools have been used.

An unusual case of a 35-year-old woman with COVID-19 pneumonia who suddenly desaturated while on continuous positive airway pressure leading to pneumomediastinum and surgical emphysema thereby requiring ventilatory support in intensive therapy unit. It is unclear from history and clinical assessment; whether this complication was directly related to COVID-19 pneumonia and it worsened with the initiation of CPAP, OR it was a direct complication of CPAP. [ABSTRACT FROM AUTHOR]

The number of patients requiring tracheal intubation rose dramatically in March and April 2020 with the COVID-19 outbreak. Our thoracic surgery department has seen an increased incidence of severe pneumomediastinum referred for surgical opinion in intubated patients with COVID-19 pneumonitis. Here we present a series of five patients with severe pneumomediastinum requiring decompression therapy over a 7-day period in the current COVID-19 outbreak. We hypothesise that the mechanism for this is the aggressive disease pathophysiology with an increased risk of alveolar damage and tracheobronchial injury, along with the use of larger-bore tracheal tubes and higher ventilation pressures. We present this case series in order to highlight the increased risk of this potentially life-threatening complication among the COVID-19 patient cohort and offer guidance for its management to critical care physicians. [ABSTRACT FROM AUTHOR]

Post-tonsillectomy emphysema is an infrequent yet critical complication that follows tonsillectomy - a prevalent surgical procedure for treating conditions like recurrent tonsillitis and obstructive sleep apnea. While tonsillectomy is generally safe, it is not without risks, including the rare occurrence of postoperative emphysema, where air accumulates abnormally in the neck and head's soft tissues, potentially leading to severe respiratory distress. We present a case of a middle-aged female who underwent tonsillectomy and subsequently developed symptoms indicative of post-tonsillectomy emphysema. Diagnosed through a combination of physical examination and imaging, her treatment involved conservative management and careful monitoring, ultimately resulting in full recovery without the need for surgical intervention., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alzamil et al.)

This report details the pathological and radiological findings in a rare case of massive subcutaneous emphysema. A 74-year-old male presented with sudden onset dyspnea and facial swelling following a fall. His symptoms were refractory to treatments for anaphylaxis, which was suspected clinically, and he quickly succumbed. Autopsy, including post mortem CT scan revealed the underlying etiology to be multiple rib fractures with rupture of the parietal pleura, bilateral pneumothoraxes and massive subcutaneous emphysema involving the face, torso and upper limbs. Multiple frothy air bubbles were observed throughout the mediastinal adipose tissues on internal examination. Our findings echo those of rare previous reports and show how subcutaneous emphysema may, in rare circumstances, mimic anaphylaxis. [ABSTRACT FROM AUTHOR]

Background: Emergency tracheostomy is the commonest surgical intervention performed as lifesaving procedure by ENT surgeons on patients in emergency room of ENT and ICU. Several operative and postoperative complications have been reported after tracheostomy including fatal hemorrhage. Massive subcutaneous neck emphysema occurred because ventilation started at the time when the hemorrhage was not completely managed and the tracheal tube was not fully secured. Objective: This study was conducted to compare haemorrhage and surgical emphysema as complication of emergency tracheostomy among patients admitted in Department of ENT and Head-Neck Surgery in Dhaka Medical College & Hospital. Methods and Materials: This was a Cross Sectional Study conducted in the ENT and Head-Neck Surgery Department, Dhaka Medical College Hospital from July 2015 to June 2016. A total of 90 patients were included who fulfilled the selection criteria. Non probability convenient sampling was used to collect data. Statistical analysis was done by SPSS version 21. Results: Mean± SD of the study subjects was 49.84±17.4 years with most patients belonged to 40-79 years age group. 28.9% patients had habit of smoking and betel nut chewing. (48.9%) patients suffered from Ca larynx. Out of 90 tracheostomy patients, 40(44.4%) patients had had different complications including haemorrhage (13.3%), surgical emphysema (10%), haemorrhage with surgical emphysema (6.7%), tube blockage (3.3%), wound infection (3.3%) and injury to local tissue (2.2%). Haemorrhage occurs from anterior jugular vein, middle thyroid veins and thyroid gland and included peroperative haemorrhage (7.8%), immediate post-operative haemorrhage, <24 hours, (4.43%) and late post-operative haemorrhage (1.2%). Conclusion: In this study, haemorrhage followed by surgical emphysema and haemorrhage with surgical emphysema were found as major complications following emergency tracheostomy. [ABSTRACT FROM AUTHOR]

Background: Peri-orbital surgical emphysema is a rare complication that can occur after lacrimal surgery. It has only been described in isolated cases, following external dacryocystorhinostomy (n = 2) and Lester Jones tube insertion (n = 1). Method: A retrospective, non-comparative case series was conducted of patients who developed surgical emphysema following endoscopic dacryocystorhinostomy. Results: A total of 356 endoscopic dacryocystorhinostomy cases (primary, n = 316; revision, n = 40) were performed over a six-year period. Seven cases of post-operative surgical emphysema were identified, all of which were preceded by uncontrolled sneezing, nose-blowing or coughing within the first week of surgery. The occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy in our centre was 7 in 356, or 2 per cent, over six years. Conclusion: This is the first study to report the occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy. Clinicians may wish to suggest patients stifle the aforementioned triggers within the first week to reduce the potential for surgical emphysema. [ABSTRACT FROM AUTHOR]

Surgical emphysema is as an iatrogenic complication whereby air is dispersed within the tissues following an invasive procedure. It is relatively uncommon, however, it has been recognised that dental extractions and the use of air turbine drills can result in this complication. Here, we discuss a case report of a 35‐year‐old male re‐attending with extensive surgical emphysema following a seemingly uncomplicated dental extraction, caused by playing with his baby. This case was unusual because no dental air turbine drill was used during the dental extraction, and due to the innocuous patient activity that caused the emphysema. Consideration of the aetiology, prevention and recognition of surgical emphysema are discussed. [ABSTRACT FROM AUTHOR]

Introduction:Subcutaneous face and neck emphysema secondary to colonic perforation is a rare complication of colonoscopy. Presentation may be complicated by pneumothorax and/or respiratory distress. Evidence limited to case studies. Therefore, no management consensus of these rarely reported cases exists. Methods:All cases published on PubMed between 1 January 2000–1 November 2016 reporting subcutaneous face and/or neck emphysema after colonoscopy are included. Management is discussed with trends identified. We report a case of a patient undergoing routine polypectomy who developed subcutaneous emphysema of the face, neck and thorax with a pneumothorax and pneumoretroperitoneum. Results:37 cases were found (mean age = 64.1 ± 15.09 years). The majority (n = 24) were managed non-operatively. Conservative and operative management had mean inpatient stays of 7.6 ± 4.65 and 19.5 +/- 21.62 days respectively. Sixteen cases had a concomitant pneumothorax with nine (56.3%) requiring decompression. No mortalities occurred. Conclusion:An understanding of anatomy heightens awareness of the rare complication of face and/or neck surgical emphysema, secondary to pneumoretroperitoneum and pneumothorax, after perforation of the colon during endoscopy. Management remains controversial with expectant conservative bowel rest with antibiotics and operative intervention described. Conservative management had a shorter inpatient stay and was more common in younger patients. [ABSTRACT FROM PUBLISHER]

A 29 year old male patient of Indian ancestry was admitted to an outside hospital with rapid deterioration of his level of consciousness. The patient required mechanical ventilation and transfer to MICU at Hamad Medical Corporation. The patient remained hypoxic. Chest X-ray, CT of chest, abdomen, pelvis and proximal areas of both lower limbs were performed. Pneumomediastinum, pneumoperitoneum, and extensive surgical emphysema were the diagnoses.

Abstract: Background: Subcutaneous emphysema of a limb after acute injury is classically associated with gas gangrene. Delayed management can result in amputation and death. Typically caused by a clostridial infection, patients are unwell, with rapidly spreading clinical signs, abnormal laboratory results, and cultures positive. There are reports of widespread subcutaneous emphysema of a limb in well-appearing patients, with blood parameters within normal limits; however, the optimum management of this type of case is unclear. Objective: Our objectives were to present 4 new cases of acute subcutaneous emphysema in well-appearing patients managed with early surgery, review the literature, and discuss the management decisions in cases of acute subcutaneous emphysema in clinically well patients. Case reports: Here we present a case series of 4 patients, all with penetrating injuries to the upper limb resulting in widespread subcutaneous emphysema within 24 h of injury. Mean age was 33 years. All were fit and well, with the exception of one with type 1 diabetes, no cardiorespiratory compromise, and no significant derangement of laboratory investigations. X-ray studies showed widespread gas within the soft tissues. All were treated aggressively with immediate surgical fasciotomy of the upper limb, thorough debridement, and washout as required. Gram stains revealed pus cells (polymorphonuclear leucocytes) in all, but organisms in only one case (Gram-positive cocci and bacilli). Prolonged culture grew organisms in all. All patients had a second washout and closure plus 6 weeks of antibiotics. All survived and had fully functioning limbs. Why should an emergency physician be aware of this? We recommend having a low threshold for rapid referral to an appropriate surgical speciality, allowing prompt and radical surgical management of this type of presentation, even in the presence of a well patient. [Copyright &y& Elsevier]

Pneumomediastinum is usually associated with subcutaneous emphysema and pneumopericardium, but rarely associated with pneumothorax and epidural pneumotosis. We report extremely rare simultaneous occurrence of self-limiting pneumomediastinum, pneumopericardium, surgical emphysema, pneumothorax, and epidural pneumotosis in an 18-year-old gentleman in the absence of identifiable cause. [ABSTRACT FROM AUTHOR]

Pneumorachis, the presence of free intraspinal air, is an exceptional radiological finding. We present a case that sustained injury following an assault and was diagnosed to have diffuse pneumocephalus, pneumorachis and extensive surgical emphysema of the head and neck region secondary to the fracture of the cribriform plate of ethmoid bone. To the best of our knowledge pneumorachis due to fracture of the cribriform plate of ethmoid bone has not been reported before, in the English language literature. [ABSTRACT FROM AUTHOR]

The article presents medical cases where extensive surgical emphysema occurred during laparoscopic surgery. It details the case of a 77-year-old Hong Kong Chinese woman presented for a laparoscopically-assisted left hemicolectomy under general anaesthesia. The authors discovered that the carbon dioxide production during laparoscopy increased linearly for the first 8 to 10 minutes and then reached a plateau for the rest of the procedure.

A case report of surgical emphysema following adult cochlear implantation. The clinical picture, investigations and management of this rare case will be discussed. [ABSTRACT FROM AUTHOR]

Tracheal rupture represents a rare but serious complication of intubation. We discuss a case of a major post-intubation rupture. After investigation with CT scan tracheoscopy and bronchoscopy a low tracheostomy was formed protecting the rupture from pressure changes associated with ventilation. The patient was managed with minimal surgical intervention, low tracheostomy with antibiotic cover and monitoring in the intensive care unit for 24 h before being woken and moved to a ward after 48 h. The patient made a full and uncomplicated recovery and was discharged 2 weeks after the original injury. Most of the literature on the subject is made up of review of case reports that conclude management of such a major tear must be with surgical repair. This however confers significant morbidity and an associated high mortality. We suggest an alternative management protocol. [ABSTRACT FROM AUTHOR]